The acquisition of Merck KGaA by P&G is interesting on lots of levels and it reflects some of the seismic challenges/opportunities the consumer healthcare industry faces at this point of change.

Why is P&G committed to healthcare/wellness? It probably reflects what we already know; the industry is doing ‘ok’, but the future potential is HUGE – we are still just struggling to define a journey to get there! P&G CEO David Taylor recently defined this growth potential based on… ‘The 3 megatrends that have supported the growth of OTC healthcare for the past decade should continue for many years to come.’ The 3:

Ageing population – over 65s population doubling to 1.6B by 2050

Wellness/Quality of life – aging populations focus on quality/outcomes and will invest in achieving it

Need for control – consumers are – slowly – getting that they need to drive this. No-one will do it all for them & they need info/support and relevant solutions to do this. Sadly, most regulators and many HCPs don’t get this ‘truth’ yet…

Scale aint what it used to be! This is also a tacit acknowledgement that the hegemony of global scale is over – in truth, it never really got going in OTCs. P&G know a thing or three and this deal wouldn’t have fitted their $ billion plus asset model of recent times. It is about smaller, specialist brand assets targeting interesting future-potential high margin wellness needs – this is a strategic change. Whether Nelson Peltz’s agitation is behind it or not is, in the end, moot, but in consumer healthcare this is interesting and it drives 3 mega-challenges:

New marketing models. To capture more growth the big OTC/healthcare players need to consider their investment models and global vs local balance – superior audience data/understanding will be key & influencing/expert strategies will need to change. We’ve wasted too many years ‘imagining’ that consumer healthcare is just like FMCG – it isn’t – this has driven some poor strategic choices.

Fighting commoditisation through ‘service’ and trust. Brands might or might not be facing an existential crisis [Link to Bain & Co article ] but in healthcare where generic solutions and regulatory constraints abound we need to define how we add value vs ‘the ingredient’ and the endless – partly ridiculous – rhetoric that savvy people buy own label. Amazon et al are magnifying this. But, we still believe, that better marketing – strong data/insight, more relevant products, information & service integration into e-commerce models etc. – can still create a world where consumers/shoppers TRUST brands with their health. The nature of this trust relationship is a fundamental truth that can differentiate us from FMCG. Healthcare must resist becoming transactional – an unintended consequence of mass market/mass retail/FMCG mindset.

Regulatory change. Underpinning this is a pressing need to drive regulatory/access changes to facilitate more marketing – this mustn’t be an ‘unfettered’ free market wild west – but if the industry is tasked with driving behavioural change then marketing, not healthcare systems/governments, will make it happen.

This makes us feel really positive. These are the challenges we & Creative Leap want to work on.

This is BIG STRATEGY and not enough of the industry is reflecting on, or talking about this stuff.

It’s complex and multi-faceted. A blend of big data and big insight. A need to be highly commercial – but with creativity and marketing at its heart. As sad consumer healthcare geeks we’re always happy to talk about the above subject matter with likeminded souls! So, get in touch.

Most of us have heard of the ‘new phenomena’ promising unimaginable riches to early stage investors and disruption to traditional business models on a scale never seen before.

Is it just hype or the beginning of the end for traditional approaches to retail, banking, healthcare, supply chain etc.?

A sliver of cynicism is useful at this point. We’re old enough to remember the dot com crash when we had offers of sweat equity in exchange for free consultancy from eager young people who scoffed when you asked to see their business plan. Sadly, Jeff Bezos never approached us, or it might have been a very different story. But, we must not be luddites. This is happening.

So, what is Blockchain?

We’re not qualified to give the definitive answer, but…

‘It’s a distributed and immutable (write once and read only) record of digital events that is shared peer to peer between different parties (networked database systems)’.[1] It is the levels of data integrity that is fueling the potential. The value in finance seems obvious, but it is also really interesting in healthcare where personal, exploitable data and high levels of regulation abound.

The current issue is that the layers of utility that might be offered above this core functionality is, to date, largely unproven and snake oil sales-persons are everywhere! We are certain that, like the development of the internet, things will come… and go… before we find a modus operandi on which to build. It’s likely that, even then, 2nd and 3rd generation developments will disrupt this along the way just as mobile has with digital. One thing is for certain, it is not a panacea for any struggling industry, business or model. Nothing is ever so neat as to ‘save the day.’

There are lots of areas for exploration, but two immediately interest us in healthcare.

A recent example we saw, however, clarified the potential of the first point and demonstrated how this could quickly impact on the healthcare sector.

Cannabis, IBM and government of British Colombia

IBM has approached the government of British Columbia to help them integrate blockchain technology into Canada’s soon to be legalized cannabis trade.

According to an article published by WARC[2] IBM writes “Blockchain is an ideal mechanism in which BC can transparently capture the history of cannabis through the entire supply chain, ultimately ensuring consumer safety while exerting regulatory control – from seed to sale.”

The article goes on to explain that “the ledger is immutable, with cryptography ensuring that the transactions (blocks) once entered into the ledger (chained) can never be altered.” This also delivers transparency, as all shared ledgers across the network hold all transactions from all parties.

For the government, this ensures control and the potential to “eliminate black market sales completely.” For producers, the technology can assist with real time inventory management, supply and demand projections and consumption trends and data analytics capabilities.

We can all see where that might take us with pharmaceutical supply chain, distribution and business models. It is a potential ‘solution’ to one of the big concerns for regulators – the borderless healthcare transaction – as it can track the transaction with total integrity and can be matched to the local regulatory and safety needs throughout. We are also sure it will challenge and worry regulators, especially in Europe, where they are not famed as innovators!

Personal data, empowerment and consumer healthcare/wellness?

Of more interest to us, who live in a world of people and insight versus global supply strategy, is the potential of Blockchain to enable us to share highly personal data with security and protection. Ultimately, and this is a breakthrough in trust and empowerment, there is no reason why the patient cannot be part of this chain versus a faceless healthcare provider ‘holding’ data on our behalf and occasionally losing it! Currently there are no established protocols for this. We don’t know, but we imagine there is a feeding frenzy of suppliers etc. trying to get into this market. So, when, how and if it becomes truly scalable is beyond us!

The question we ask, and would appreciate feedback and answers on, is whether, in the medium term, this is where the potential for consumer healthcare businesses/brands lies? This is part of a broader question we repeatedly ask about how we can use personal healthcare data in the self-med space to improve lives and wellness without being uncomfortably beholden to a Facebook or Google?

We all see the value of patient-data for ‘serious’ conditions and see the value of securely managing it in a way Blockchain potentially offers. But this must also be relevant for people’s everyday health, happiness and wellness data. Currently, people are sharing data with an openness that is potentially foolish with unforeseen consequences. They are, despite inadequate integration attempts by Google and Apple, storing any data they have – from wearables & other devices, a few apps on sleep or allergies and occasionally implants & data capture that are linked to more serious medical conditions – in an ad hoc way.

It seems that there is a wellness opportunity here. For someone to build an integrated store of personal wellness/health information – ignoring the artificial boundaries of health system/Rx and self-medication/wellness – that is ‘owned’ by and empowers people to make the data actionable. People are already considering this in the ‘app’ space, but what Blockchain does very successfully is to theoretically enable 2 things: protection – controlled by the individual as they are central to the network – and integration of discrete data sets. The challenge for brands will be that they aren’t best placed to do the integration part which means they will increasingly need to engage with the consumer on their terms, in their world.

This holistic, data-led world is creating a fundamental engagement problem for brands and portfolio owners. How many relationships does the consumer need or want with health and wellness brands? An app for brand x in allergy or brand y for your skin condition is not irrelevant, but will only work for the consumer if it is simple and integrated into a broader solution. A one (or few) stop shop versus 25 points of data; 25 apps or 25 daily interactions in the self-med space? many of these problems are not serious enough to demand this effort, but people care enough to want relevant, specific benefits. What they will increasingly shun is the complexity of multiple interactions. Life is too short! (FYI, we are planning to share some more detailed insight on this soon)

So, we see the challenge for brands is the same as ever, but needing to work in a new context. These new technologies will build new ‘channels’ – either for communication or commercial interaction with customers and consumers. Some might fundamentally change the business model, while others will simply change the route to market.

Wherever we end up, brands still need to focus on what we call creating meaningful difference. A single-minded focus on driving relevance and distinctiveness. What Blockchain and new technologies do is fundamentally change and increase the challenge & opportunities that brands have to create relevance beyond the product. Brand owners are not usually very good at this. It’s hard.

We try to keep it simple and we would recommend (in thinking brand strategy vs supply) reviewing these new technology-led platforms and 3rd party initiatives through these two basic lenses:

It is a potential route to market? Decision – do we want to play here or not? Do we have to play here for strategic reasons? Or most often – let’s test and learn, rapidly on a small scale

Is it an engagement/relevance opportunity? These are simply more ‘touchpoints’ and interactions that can unlock insight and potentially drive relevance.

We rarely believe in inhabiting the bleeding edge. Our approach is the basis of fast following and evolving/defending your brand assets in the face of complexity and change. We accept that the speed of change might overtake us, but would argue that these two points will still apply and the pressure will be the speed at which we have to change direction.

But, never forget, your fundamental relevance comes from your ability to solve people’s problems; the jobs they need to do. Blockchain will not impact on large parts of this… immutable data integrity never offered fast effective pain relief for a headache.

So to conclude, BLOCKCHAIN does have the potential to, and probably will, transform healthcare and the role of personal information about our health. Is it anytime soon? Hard to say, but it seems that the disaggregated approach of the industry to solving this means a period of chaos before true value and integration emerges.

It’s going to happen, so watch this space, but perhaps, we recommend, don’t hold your breath.

[1] ‘Does Blockchain have a place in healthcare?’ Reenita Das on Forbes.com, 8/5/17

Serendipitously, a week after publishing a post on rational/emotional approaches in healthcare marketing, we saw a really fabulous presentation by David Golding, founder of Adam & Eve[1] entitled ‘Engaging the heart – the role of emotion in building brands’.

There was a lot about the John Lewis Christmas ads – if we’d made them, we’d talk about them too – but, far from one-dimensional.

He highlighted 11 success factors for making emotional ads. Not our place to steal his thunder, so, if you have a brand and a budget, call him and ask him to share! We’ve been making ads/working with brands for a long time and we both enjoyed it and learnt stuff.

Two things he said that were particularly relevant to our previous piece:

Not all brands can do emotion. David graciously added, that the success of the John Lewis ads in delivering high emotional engagement would not have been possible without the residual love of the JL brand. The point is that – chicken and egg like – lots of healthcare brands are not found in the ‘love box’. They work so hard at building their rational platform, or their raison d’être and relevance doesn’t live beyond their rational benefit that is might sometimes create an insurmountable barrier to doing the emotional thang? Or, in doing so, it might distract from what they are actually good at.

Find a truth, a narrative or story, in the brand DNA or heritage or… Find something that you can use to build the emotional platform, because in most, especially OTC categories, whilst the suffering or problem can be emotional, this is not easily ownable or leverageable by the pills etc. that offer respite. It is a highly personal space and we are not needed or invited there. A bit like banks telling us they want a ‘relationship with us’ [current advertising for one of the big ones], it’s not the key source of relevance. It’s a reason not to buy!

We would add that unlocking visceral emotional connections with a runny nose, piles or acid reflux is also just plain hard. To repeat, we know that these issues can have an emotional impact on people’s lives, but that’s not always permission for a healthcare brand to leverage it. Even in categories like smoking or weight loss or sleep (all of which we’ve worked in) there is an established distance between the huge emotional relevance and deep personal relationship people have with these subjects and what they want from a brand/solution. In part, it’s about sharing and openness and we can only occasionally do it e.g. Nicorette[2] often does it really well in NRT, but we also see it try and fail!

So…our solution?

Find the meaningful difference that will make your brand win. Don’t artificially think in terms of rational or emotional. It will follow because the meaningful difference will almost always contain both elements.

This will start with a single-minded focus on relevance and the first box to tick is the benefit you deliver and how you explain that it is ‘better’ than the competition.

Then drive distinctiveness. Your fame and memorability. Here we recommend, despite all of the above, that you DO look for emotional connections. Firstly, through great insight around the person’s needs. Then, through trying to associate your brand with it. But, don’t do it just because it’s received wisdom. If you can do a better job on relevance through rational ownership of the job at hand… just do it. You can still use design and creativity to be distinctive. The Nurofen ‘target’ logo did as much for the brand as most of its historical communication. It was even the basis for some of it.

To conclude, I suppose what we are saying is to start somewhere different and arrive at your emotional tone of voice and connection discussions once you’ve determined how you’ll win. We do lots of really emotional stuff, but it never starts with a quest for emotional work. It starts with a quest to be meaningfully different. Maximise relevance and maximise distinctiveness – the rest will follow.

In brand marketing, it is increasingly the received wisdom that successful brands/communication are more effective if they deliver emotional engagement, not necessarily exclusively, but above all else.

The debate is not new. We’ve been talking about emotional engagement based on deep human truth/insight for years. It is the inevitable result of a world where genuine product USPs are unicorn-rare and most categories are becoming commoditised and intensely competitive.

It is the source of endless client-agency ‘discussions’. The clichéd image of clients fighting for more of their features and benefits with a big RTB [alongside more and bigger logos]; the agency wanting to make a great, visceral, human truth film that will sell itself regardless of any overt branding. The reality? There is right and wrong on both sides.

There was lots of fast brain/slow brain/behavioural economics – Kahnmann et al – and some compelling evidence for the need for communication to engage emotionally as well as rationally.

So, for the record, we totally, 100% agree with the narrative on the primacy of delivering emotional engagement.

But, thinking about healthcare/OTC it is important to acknowledge some potentially different dynamics that might de-prioritise emotional messaging – at least short term, or at key stages of brand/category development.

In all categories penetration is usually driven by relevance and distinctiveness. Fundamentally, brands/products need to meet needs – relevance – and they drive competitive advantage through doing this distinctively – they are better, cheaper or perceived as different or more ‘for me’ versus competitors.

OTC categories are not fundamentally different, but…

The ‘but’ is that, at certain stages of category development, or if you have a small, probably short term, window of ‘uniqueness’ in which to establish your Meaningful Difference it might be best to temporarily de-prioritise emotional engagement and put the foot to the metal on some rather dull, sensibly rational claims; to focus on practical relevance.

The evidence?

If you look at many of the truly mega success stories they have all been [at least initially] achieved with little interest or delivery of emotional connection. The focus has been driving relevance by demonstrating an ability to meet the consumer’s core needs either better or differently or by owning the generic benefit through a ‘killer’ claim.

Nurofen. Built its leadership entirely on a clever RATIONAL story. Targeted pain relief. With a fabulous RTB – because it works at the site of pain. You can explain its initial success through being new/innovative – but not its sustained growth. There is little evidence it has ever been truly emotionally engaging, but it is a brand to die for.

Sensodyne – now a billion-dollar brand – built itself on single-minded RATIONAL problem-solution communication – it stopped sensitive teeth. The advertising either expresses the problem or uses dentists to re-enforce the rational benefit/trust in efficacy.

Corsodyl/Parodontax – a true success story based on blood in the sink = gum problems [Symbol] Corodyl solves it. Basically, problem solution. We suspect it needs to build more emotional connection to reach the next level, but…

NB none of these brands deliberately ignores emotion. It’s just they built mega-brands without much focus on it. In fact, when they try to lessen rational relevance and increase emotional engagement… sales have had a tendency to dip.

It is fair to say that – at least briefly – they were relatively ‘unique’ solutions, so rational became more powerful. But, through sticking to the model, even when it got more competitive, they still grew… and grew.

It is important to acknowledge that in the medium term this can create issues. It’s hard to move from a simple, rational platform to suddenly turn on emotional engagement. Which, as a category grows and becomes more competitive, might be key to driving distinctiveness.

One of us (Tim) spent many years globally competing with Nurofen and knows the reality first hand.

‘We used to get endless research telling us Nurofen was ‘cold’/’clinical’ and lacked emotional connection with consumers [versus our brand, Panadol]. All we had to do was leverage this – because people need/want emotional connection and… But our real-world experience was that in many cases the same consumers who questioned Nurofen’s lack of warm, fuzziness… still bought it, repeatedly, even when our ads scored higher on emotion. They relied on it and trusted it to work!’

This article is not in any way an attempt to justify dull, insight-less, rational/problem solution communication in OTCs. Or to question the power of emotional engagement. Heaven forbid. But, our point is, we do not see enough evidence of people thinking from both ends of the challenge.

Our simple point is that, sometimes, it might be best to focus on being best at delivering against the core needs of the category via some rational messaging [always supported by an insight or two of course] to drive your relevance. This is especially true in categories where consumers are not very interested, or at least it is hard to drive, emotional engagement i.e. all OTC categories!

Most OTCs work like this. You don’t always see the relevance of your slightly bleeding gums – it’s not a matter of life and death. You don’t care about Beechams – until you have a cold – in fact it’s invisible. But, when a cold strikes your fast brain will kick in. You anchor into the category’s core benefits and use heuristics around symptom descriptions and suffering images to find your solution. Emotion is not irrelevant – you might well feel quite emotional – but I would bet money that your fast brain short cuts are seeking functional product relevance more than ‘this brand understands me’.

Professor Patrick Barwise1 has written extensively on brands. His books Simply Better/Beyond the Familiar written with Sean Meehan put forward [among other things] a persuasive narrative that the brands that win in categories [as defined by share and market value] are not the ones who are ‘different,’ but usually the ones who are best at meeting the core needs of the category. This applies in healthcare with bells on.

So, if you manage some healthcare/OTC brands before you set out to be different spend some serious, expert brainpower/time trying to unlock some rational ways to drive your relevance –defining the emergent and established drivers of your Meaningful Difference.

Make sure your agencies/partners understand this and are able to supply healthcare expert input. They need to be au fait with this rather unsexy modus operandi (the science, regulations, HCP mind-sets and all that) and be specialist enough to get the differences in behaviours and insights in healthcare. Obviously, they need to be creative too. Even, if you decide that you need to be more emotional, the exercise of defining your ‘rational core’ will deliver a rip-roaring RTB. Only a healthcare expert/agency can deliver this level of meaningful difference.

The risk? You can spend lots of time endlessly sticking tails in donkeys – eyes closed – in the search for end of the rainbow emotional engagement. Truth might be the consumer just needs you to tell them why they actually need your products…

Creative Leap is a health & wellness/OTC specialist agency. We help brands to grow and find their Meaningful Difference through expert, insight-led (emotional and rational!), brand and communications input. A conversation costs nothing, so contact David Gray on 020 7549 0700 or for Muzeable, Tim Brooks on 07802 531578

Our piece[1] on new approaches to consumer healthcare claims and real-world outcomes data was read by over 2000 people, thanks!!

Several weeks have passed and we thought it would be interesting to share some of the questions/discussions and insight it generated.

Overall, healthcare marketers seem to share our optimism – the approach has legs. But, we would like more input from our clinical/regulatory colleagues, so don’t be shy! The whole point is to create collaboration across disciplines and experience tells us you will add value. Key inputs so far:

Hybrid approach. To the previous point, everyone agreed that it requires a ‘hybrid’ approach blending the best qualities of clinical study and data expertise alongside hands-on commercial/marketing and ‘innovation’ experience. Most also felt this was, if not unique, different from most available input. People shared personal stories of ‘clinical’ work that lacked the behavioural insight required to deliver commercial value and creative/ideation approaches that simply did not understand or failed to meet the technical/clinical hurdles the business/regulators needed to be truly ‘usable’. Or people who offered both, but lacked the suite of skills.

One ‘killer’ question keeps popping up. It’s a good one, it goes like this…

‘Ok. So, I get that we can drive strong communications claims in a market like the UK, but will this approach produce data that can go on the label and therefore be used in other markets and/or go on the pack’.

Honest answer. This is tough!!! Given the ‘boxes’ on the standard SPCs/PILs in Europe it is hard to see where to physically put PROM-type data [another example of the regulatory approach not really matching self-medication needs given that these data could potentially be helpful to consumers/patients making choices.]

The Wirkungsweisebox on a German label, for example, where the data that explains what the drug does is presented, could theoretically include other useful usage information on the ‘operation’ of the product in the ‘real world’ beyond the ingredient modes of action. But, we all know this runs counter to the philosophical position of most regulators.

That said, since the output will be robust, well produced [to clinical standards], published data and a well-run project would produce a data-set, not a single paper it has the potential to pass the basic acceptance hurdles of the regulators/clinicians and be worthy of discussion.

Big Pharma is not using PROM on labels, though they are using it for serious purposes with regulators/government to explain value/justify pricing and show differences/patient benefits in an attempt to influence prescribing behaviour.

In effect, that is similar to the aim here – to show brand difference/distinctiveness to influence choices via robust, supportable data/claims – but, we need the data be ‘publicly’ usable with people not just used in-camera with HCPs. Currently, in most of Europe, that needs it to be on the label.

So to be honest this requires a brand owner to run up the hill, innovate and have the patience to ‘work with the authorities’ to get relevant data on the label and build a test case. This is a long-term commitment with no guarantee of success. But, we struggle to see what the alternative is for brands? If they do not take on the challenge of changing regulations to facilitate better self-medication and more marketing they are on a long, slow slippery slope to a universe filled with Amazon own-label!!

The industry should [and it isn’t really] tackle the fundamental challenges around the ‘future of self-medication’. Our small innovation is at the heart of this. We [brands/own label/generics etc.] need self-medication labelling regulation etc. that is specifically designed for self-medication, not a sub-set of Rx with its completely different needs/safety issues. WE DO NOT CURRENTLY HAVE THIS… industry needs to take a deep breath and FIGHT FOR IT! Yes, it’s better than it was, but…

So, creating a box on the label outlining relevant, proven, robust behavioural data outlining how people using the brand/product in the pack they have bought or are thinking of buying have got best results or positive outcomes – including PROM studies – seems relevant. Dare we say… helpful even! It is part of the need to put people at the heart of healthcare and explain the benefits [not just the actions] of the product to people to enable them to see its relevance. Yes, this is marketing, but as long as it is based on good data and it all happens on a level playing field [e.g. companies that invest in the data can protect it] and own label/generics can play too, where is the issue?

OTHER STUFF…

Evidence Portfolios. The idea of building a brand specific [owned] data set versus a single study approach also resonated – we call this evidence portfolio creation.[2]It is what R&D plans to do anyway, yet, when we review our own experience of OTC clinical work (infrequent as it is) we have seen little evidence of the approach we propose. We rarely focus data creation on the end user outcomes and using that to build a multi-layered portfolio of evidence seeded in public domain and cross referenced to maximum effect. Data is usually targeted against a specific need. Nothing wrong with that, but it might not be optimising the opportunity of the investment. We are perhaps most excited about the potential to repurpose and add value to this existing data – it seems a cost-effective shot to nothing!

Many people felt this was a big behavioural change for brands/marketing who see communications as an ‘FMCG’ consumer/emotional engagement task – and it is – but this usually positions data/claims as ‘content’ to improve their ads. Since we usually advertise our NPD this can make it very short term. To start with a consumer experiential model to drive relevance and distinctiveness is a big change requiring investment decisions/changes. That said, real world outcome claims around NPD sounds like a good idea.

Social media? Lots of cynical questions about the use of social media data to build a quantitative frame of reference. What the discussion showed is [apologies to anyone who thinks we might mean them!] how little marketers understand about the potential of these data. Clinicians understand even less. Done properly this is a massively valuable input. Don’t imagine this would be a bit of blunt, possibly interesting, but completely unactionable slice of social-listening data. We see lots of this, and apologies to clients who do it, but save your money. Clever people with proprietary approaches, mashing together multiple data sources and using/analysing the data and connections are producing some of the most powerful insight, influence and targeting work we’ve ever seen[3]!

Methods? Lots of questions on methods etc. firstly, it isn’t off the shelf, so it is hard to put into a box. But, since none of the basic methods – sample creation; mobile data capture; questionnaires; product use; statistical analysis etc. etc. are ‘new’ – it’s the packaging up and outputs that are innovative – we don’t see this as the area for debate. If we set up and agree outcomes the study/trial will behave in a similar way to other work you’ve done. It’s the outputs that are different, based on a fresh way of looking at data and how they work.

How much will it cost? Lots of questions on cost. How long is a piece of string? As said, definitely much cheaper than full scale clinical work and with a better PTS; more expensive than a few workshops for sure. Two comments… the journey can be started slowly [i.e. proof of principle before a major study] and the ‘pre-work’ gives you a milestone to say go/no-go before the button is pressed whilst building a powerful input on your existing claims potential/landscape. You can even write up and publish the pre-work! In the end, having done claims work for a few decades now, we have a reasonably high confidence on some ROI.

Again, we think the answer is to talk about this stuff in the context of specific needs vs theoretical constructs. We’d rather jump through a few hoops to demonstrate the value than write articles; in reality a few documents and blogs are frankly irrelevant versus a SPECIFIC exploration/discussion of your brands and categories.